Reference limits for chromogranin A, CYFRA 21-1, CA 125, CA 19-9 and carcinoembryonic antigen in patients with chronic kidney disease.

BACKGROUND: Patients with chronic kidney disease (CKD) may have increased plasma concentrations of some tumor markers even when no cancer is present. Previous studies have indicated that plasma concentrations of chromogranin A (CGA), cytokeratin 19 fragments (CYFRA 21-1), cancer antigen 125 (CA 125), cancer antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) are higher in patients with CKD but without cancer, than in healthy individuals, and this can make interpretation of results more complicated. The aim of this study was to establish reference limits for these markers in patients with CKD not receiving dialysis and with no clinical evidence of cancer. METHODS: We measured plasma concentrations in samples from 131 patients with CKD due to various etiologies and studied the association of tumor marker concentrations with estimated glomerular filtration rate (GFR) and other patient characteristics. RESULTS: Estimated reference limits for plasma CA 125, CA 19-9 and CEA were approximately the same as for healthy populations. Serum concentrations of CGA and CYFRA 21-1 correlated strongly with estimated GFR, and GFR-dependent reference limits were estimated. CONCLUSIONS: GFR-dependent reference limits for CGA and CYFRA 21-1 are reported in order to support interpretation of these markers in patients with CKD.

A prospective study of screening for hypertensive disorders of pregnancy at 11-13 weeks in a Scandinavian population.

OBJECTIVE: To investigate the prediction of preeclampsia and gestational hypertension using maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtAPI), pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) at gestational weeks 11-13 in a Scandinavian population with a medium to high prior risk for developing hypertensive disorders of pregnancy. DESIGN: Prospective screening study. SETTING: National Center for Fetal Medicine, Trondheim, Norway. POPULATION: 579 women who were nulliparous or had a previous history of preeclampsia or gestational hypertension. METHODS: Women were examined between 11(+0) and 13(+6) weeks, with interviews for maternal characteristics and measurements of MAP, UtAPI, PAPP-A and PlGF. The tests were evaluated separately and in combined models with receiver operating characteristics (ROC) curves. MAIN OUTCOME MEASURES: Prediction of preeclampsia, severe preeclampsia and gestational hypertension. RESULTS: The best model for severe preeclampsia (MAP+UtAPI+PlGF+PAPP-A) achieved an area under the ROC curve of 0.866 [95% confidence interval (95% CI) 0.756-0.976]. The best models for preeclampsia (MAP+UtAPI+age) achieved 0.738 (0.634-0.841), gestational hypertension (MAP) 0.820 (0.727-0.913) and hypertensive disorders in pregnancy overall (MAP+PlGF+age) 0.783 (0.709-0.856). Using the best model we could identify 61.5% (95% CI 31.6-86.1) of severe preeclampsia, 38.5% (95% CI 20.2-59.4) of preeclampsia and 42.9% (95% CI 21.8-66) of gestational hypertension at a fixed 10% false-positive rate. CONCLUSIONS: Maternal characteristics, MAP, UtAPI, PAPP-A and PlGF showed limited value as screening tests. Further research on biochemical and biophysical tests and algorithms combining these parameters is needed before first trimester screening for hypertensive disorders of pregnancy is included in antenatal care in Scandinavia.